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Acta Obstetricia Et Gynecologica... Oct 2023Pelvic girdle pain during and after pregnancy is a major public health problem with significant daily problems for affected women and their families. There is now... (Observational Study)
Observational Study
INTRODUCTION
Pelvic girdle pain during and after pregnancy is a major public health problem with significant daily problems for affected women and their families. There is now accumulating evidence that pregnancy-related pelvic girdle pain originates from the sacroiliac joints and the pubic symphysis as well as their extra-articular ligaments. However, the heritability of the disease remains to be determined. We hypothesized that there is an increased familial risk of pregnancy-related pelvic girdle pain.
MATERIAL AND METHODS
A population-based national database linkage registry study of approximately 9.3 million individuals within 4.2 million families in Sweden with a recruitment period from 1997 to 2018. The Swedish Multi-generation register was used to find female pairs of twins, full siblings, half-siblings and first cousins where both in the pairs had a completed pregnancy. The outcome measure was diagnosis of pregnancy-related pelvic girdle pain (International Classification of Diseases-10 O26.7 [1997-2018]) in the first pregnancy. Data was obtained from the Swedish Hospital Discharge Register, the Swedish Outpatient Care Register, the Swedish Medical Birth Register, the Primary Healthcare Register, and Medical Treatment Register. Cox regression analysis was used to calculate adjusted estimated effect of the exposure variable familial history of pregnancy-related pelvic girdle pain on the outcome variable pregnancy-related pelvic girdle pain at first birth.
RESULTS
From the registers, 1 010 064 women pregnant with their first child within 795 654 families were collected. In total, 109 147 women were diagnosed with pregnancy-related pelvic girdle pain. The adjusted hazard ratio for a familial risk of pregnancy-related pelvic girdle pain was 2.09 (95% CI 1.85-2.37) among twins (monozygotic and dizygotic), 1.78 (95% CI 1.74-1.82) in full siblings, 1.16 (95% CI 1.06-1.28) in half-siblings from the mother, 1.09 (95% CI 1.024-1.16) in half-siblings from the father and 1.09 (95% CI 1.07-1.12) in first cousins.
CONCLUSIONS
This nationwide observational study showed a familial clustering of pregnancy-related pelvic girdle pain. The hazard ratio for the condition was associated with the degree of relatedness, suggesting that heredity factors contribute to the development of pregnancy-related pelvic girdle pain. There is no causal treatment available for pregnancy-related pelvic girdle pain and further studies are now encouraged to clarify the specific genetic factors that contribute to the disease and for future targeted interventions.
Topics: Female; Humans; Pregnancy; Family; Genetic Predisposition to Disease; Heredity; Pelvic Girdle Pain; Pregnancy Complications; Sweden
PubMed: 37470484
DOI: 10.1111/aogs.14646 -
Eplasty 2023Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound...
BACKGROUND
Late-effect radiation-induced wounds represent a particularly difficult category of wounds to manage and treat. Fibrosis, impaired cellular activity, ischemia, and wound chronicity all work to impair healing, and this becomes more pronounced when defects are large or when avascular structures such as bone are exposed. Effective treatment options for this type of wound are limited. Thorough excision of irradiated tissue followed by distal pedicled or free flap closure is the most successful; however, this often requires multiple-stage surgeries and prolonged hospitalization and is associated with significant donor site morbidity. This is complicated further when wounds are large or in difficult locations, when surgery is not appropriate, or when there is limited access to surgeons with the appropriate experience/skill to perform such procedures.
METHODS
This case series describes the use of an autologous heterogenous skin construct (AHSC) made from a small full-thickness sample of the patient's healthy skin. Three patients with intractable late-effect radiation wounds were treated with AHSC. Case 1 describes an abdominal wound with tunneling of 7.5 cm to the pubic symphysis, which had been treated for known osteomyelitis, and a shallower full-thickness groin wound. Case 2 describes a right scapular wound with exposed bone, which had failed flap closure. Case 3 describes a right thigh wound in a patient who had been treated for sarcoma with extensive radiation therapy. This eventually resulted in an above-the-knee amputation, which failed to heal, and full exposure of the distal end of the resected femur. All wounds had been present for greater than 10 months.
RESULTS
Mean percent volume reduction was 83% (±2.7) at 3 weeks and 92.9% (±4.7) at 4 weeks. The tunneled abdominal wound decreased in depth from 7.5 cm to 1.2 cm in 3 weeks. Complete closure was achieved at 11 weeks for the abdominal and groin wounds (patient 1) and at 16 weeks for the thigh wound (patient 3). The scapular wound volume of patient 2 had decreased by 91.8% at week 4 but was not fully restored until week 21. Mean time to closure was 16.1 (±4.7) weeks.
CONCLUSIONS
AHSC was effective in covering exposed bone, improving wound bed vascularity, filling in significant wound depth, and achieving complete wound closure with one application in patients with intractable late-effect radiation wounds.
PubMed: 37465475
DOI: No ID Found -
Quantitative Imaging in Medicine and... Jul 2023The transversus abdominis plane (TAP) block is a widely used, safe and effective technique for abdominal surgery analgesia, but its range of blocking is not sufficient...
Effectiveness and safety of new umbilical paramedian semilunaris approach for transverse abdominis plane block: a prospective, single-arm, observational, evaluation study.
BACKGROUND
The transversus abdominis plane (TAP) block is a widely used, safe and effective technique for abdominal surgery analgesia, but its range of blocking is not sufficient for some surgeries requiring a large incision. Here we present the novel concept of an ultrasound-guided linea semilunaris block, a modified approach to TAP block, which can potentially offer a wider blocking range.
METHODS
Patients undergoing open colorectal surgery at the Shanghai Jiaotong University Affiliated Sixth People's Hospital between May and July 2021 were enrolled to receive ultrasound-guided linea semilunaris block. All blocks were performed in the holding area of the operating theater under routine hemodynamic monitoring while patients were conscious with low-dose opioids. All patients were supine, and a linear probe identified the semilunar line as the connection between the transverse and rectus muscles. Next, 20 mL of 0.25% ropivacaine was injected in the semilunar line using the in-plane technique bilaterally. The main indicator of the blocking range was measured. Postoperatively, the visual analog score (VAS) from 4 to 24 h (every 2 h), the time of the first remedial analgesia, the bowel movement starting time and complications were also recorded.
RESULTS
A total of 31 potentially eligible studies were identified for inclusion. The extent of the cutaneous sensory block was: 3.46±0.59 cm below the xiphoid, 1.74±0.37 cm above the symphysis pubis, 2.02±1.24 cm outside the left midclavicular line, and 2.19±1.25 cm outside the right midclavicular line. The highest and lowest median [interquartile range (IQR)] VAS pain scores were 4 [4-5] of 10 h and 2 [1-2] of 4 h postoperatively. The bowel movement starting time was 3.7±1.1 days after gastrointestinal surgery. There were four patients with nausea and vomiting but none had adverse reactions attributable to local anesthetic (LA) poisoning.
CONCLUSIONS
The ultrasound-guided umbilical paramedian semilunaris approach to TAP block is a safe and effective technique in clinical practice, which may provide more effective analgesia than traditional TAP block for open colorectal surgery with a median abdominal incision. Further randomized controlled trials are needed to confirm our results.
PubMed: 37456323
DOI: 10.21037/qims-23-245 -
Cureus Jun 2023Pubis osteomyelitis is an uncommon disease, accounting for less than 1% of all bone infections. It occurs secondarily to hematogenous bacterial planting or direct...
Pubis osteomyelitis is an uncommon disease, accounting for less than 1% of all bone infections. It occurs secondarily to hematogenous bacterial planting or direct inoculation. Clinically, it presents with intense acute pubic pain, limited mobility, and high fever, so it is rarely suspected initially. Its diagnosis can be easily confused with pubalgia, that do not respond to treatment. We present the case of a 17-year-old patient who sought consultation for three weeks of coxalgia associated with general discomfort and fever. Following a laboratory and imageological study, the diagnosis of acute pubis osteomyelitis was determined, which required surgical intervention and a subsequent pharmacological therapy for six weeks.
PubMed: 37448424
DOI: 10.7759/cureus.40329 -
International Journal of Surgery Case... Jul 2023Pubic joint enlargement of more than 10 mm is diagnosed and defined as diastasis of the pubic symphysis and is considered a complication of vaginal delivery or...
INTRODUCTION
Pubic joint enlargement of more than 10 mm is diagnosed and defined as diastasis of the pubic symphysis and is considered a complication of vaginal delivery or pregnancy. As it is a rare pathology.
CASE PRESENTATION
We report a patient with severe pelvic pain with impotence of the left IM at day 1 of a dystocic delivery. The clinical examination revealed a sharp pain on palpation of the pubic symphysis. The diagnosis was confirmed by a frontal radiology of the pelvis showing a 30 mm enlargement of the pubic symphysis. The therapeutic management consisted in a preventive unloading and anti-coagulation with an analgesic treatment based on paracetamol and NSAID. The evolution was favorable.
CLINICAL DISCUSSION
The therapeutic management consisted of a discharge and preventive anti-coagulation with an analgesic treatment based on paracetamol and NSAID. The evolution was favorable.
CONCLUSION
The initial early management is medical with the association of oral analgesia, local infiltration, rest and physiotherapy. Pelvic bandaging and surgical treatment are reserved for cases of important diastasis and must be associated with preventive anticoagulation in case of immobilization.
PubMed: 37413756
DOI: 10.1016/j.ijscr.2023.108465 -
Journal of Orthopaedic Case Reports Jun 2023Malignant transformation of pelvic osteochondroma is a rare entity. Large size and late presentation impose threat to life as well as limb. We report a case of limb...
INTRODUCTION
Malignant transformation of pelvic osteochondroma is a rare entity. Large size and late presentation impose threat to life as well as limb. We report a case of limb salvage surgery in an enormously large secondary chondrosarcoma arising from pelvic bone.
CASE REPORT
A 60-year-old male presented with a colossal swelling at groin reaching up to distal thigh. He was walking with a wide-based gait due to pain and discomfort. 30 year back, the patient first reported this swelling of pea size, for which he was advised surgery but due to fear of surgery and economic reason he refused. Swelling gradually increased in size and reached up to distal thigh in the past 30 years. It was hard and non-tender up to 6 months back, when suddenly a change in consistency from hard to soft in distal area was noticed. On examination, a large soft cystic swelling was hanging from his pubic area. Tumor was fixed at base on proximal end. On magnetic resonance imaging, size of tumor was 281 mm in length, 263 mm in width, and 250 mm in anteroposterior diameter. Tumor was arising from superior and ischiopubic rami. However, no intra-articular extension was seen. A radiographic skeletal survey and bone scan did not reveal any other lesion. On biopsy, chondrogenic tumor composed of lobules of chondroid material with no cellular atypia or evidence of malignancy was reported. Considering the age of patient, rapid progression in recent months, size and duration of tumor, and type 3 pelvic resection was planned. Using utilitarian pelvic incision with perineal extension, separating long adductor muscles and deep femoral artery tumor, tumor excised with osteotomy at pubic symphysis, and on superior and inferior pubic rami. With minor wound complications, wound healed in 3 weeks. Post-operative biopsy reported as Grade 1 chondrosarcoma. At 3-year follow-up, the patient has no complains and no sign of recurrence noticed.
CONCLUSION
Limb salvage surgery is a suitable option even in enormously large musculoskeletal malignancy. Proper counseling and tracking of patients are must to avoid future complications.
PubMed: 37398515
DOI: 10.13107/jocr.2023.v13.i06.3680 -
Journal of Family Medicine and Primary... Apr 2023Osteitis pubis (OP) is inflammation of pubic symphysis associated with varying degrees of supra-pubic, pelvic, or lower abdominal pain. The condition may be severe in...
BACKGROUND
Osteitis pubis (OP) is inflammation of pubic symphysis associated with varying degrees of supra-pubic, pelvic, or lower abdominal pain. The condition may be severe in many patients with significant disability and protracted course of recovery. The condition is frequently described in sportspersons or athletes but consensus on classification and treatment guidelines is non-existent due to rarity of the condition. Its presence in non-athletic population is limited to a series of few cases or anecdotal case reports. Our study describes salient features of pattern of this disorder diagnosed on clinico-radiological basis in cases referred from primary care centers to our tertiary care center.
MATERIALS AND METHOD
A total of 26 patients (mean age of 36.28 years, 25 females, and 1 male case) with radiological features suggestive of OP were included in the study and relevant demographic details were noted for each. A radiological grading (Grade A to E) for notification was developed and the cases were categorized accordingly.
RESULTS
Most of the cases were hard-working women from villages. Pregnancy was the major condition for which they ever consulted a health-care facility. Chronic, but not disabling, supra-pubic pain was the chief complaint in most cases. In some cases, the primary presentation was for some other disorder like low back pain in two, hip pain in six cases, adjacent fracture in three, and old lumbar osteoporotic compression fracture in one case. Other notable associated disorders included polio, ankylosing spondylitis, femoroacetabular impingement, and hip dysplasia. Conservative management was done in all cases except one with associated fracture. Good clinical outcome was noted in all but one case. Grade A cases were maximum (7) followed by grade B (6), grade D (4), and grade C (3). Only one case of grade E was noted with almost ankylosed symphysis.
CONCLUSION
This article highlights acknowledgment and knowledge of OP in primary care settings and its anticipation even in normal population for a better understanding of prevalence and radiological presentation.
PubMed: 37312763
DOI: 10.4103/jfmpc.jfmpc_105_21 -
Indian Journal of Urology : IJU :... 2023A 62-year-old hypertensive female presented with a mass protruding from the vagina for the past 20 years. She complained of dysuria and urinary incontinence for the past...
A 62-year-old hypertensive female presented with a mass protruding from the vagina for the past 20 years. She complained of dysuria and urinary incontinence for the past 3 months. There was no history of surgical intervention in the past. The examination revealed a tender irreducible total uterine prolapse (procidentia) and cystocele with a decubitus ulcer. Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder, with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis, with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.
PubMed: 37304994
DOI: 10.4103/iju.iju_20_23